New preventative options offer hope for migraine sufferers
By Lisa Larkin, MD, FACP, NCMP, IF
Anyone who has had a migraine headache knows how debilitating it can be. They can cause you to miss work, school or just miss out on family interaction. New treatment options give hope to chronic migraine suffers that can not only treat the acute symptoms, but hopefully, prevent headaches from occurring.
Migraines affect 12% of the general population, with women developing migraines nearly three times as often as men. People with a family history are also at greater risk, and although they can develop at any age, first occurrences typically begin in adolescence– peaking in the 30s and gradually becoming less severe and frequent over time. Unlike tension headaches or cluster headaches, migraines have a gradual onset, with many people experiencing temporary nervous system symptoms, or aura, that signals the onset. Aura symptoms include visual phenomena, such as floaters, shapes and flashes or loss of vision, tingling sensation in limbs, weakness or numbness on one side of the face, and others. Migraines also may last longer than other types of headaches—from 4 to 48 hours.
The causes of migraines are not fully understood, but researchers have identified a number of triggers. These include hormonal changes (for women) due to menstrual periods, pregnancy and menopause. Other triggers include stress, sensory stimuli such as bright lights or sun glare, changes in the weather (barometric pressure), certain medications, foods and alcohol and coffee.
Treatment includes reducing the pain and restoring function, and most sufferers have taken Advil, Tylenol or Excedrin to help with the pain. However, a class of drugs called Triptans are considered the drug of choice for treating the acute pain of migraines. There are several drugs in this class, available by prescription, and studies have shown 50 – 60% of patients respond and have relief quickly. However, don’t be discouraged if a Triptan drug your doctor prescribes doesn’t work for you: often patients respond to one Triptan but not another. Your doctor might have you switch to another form of the drug to see if that one works for you.
Depending on the frequency and severity of a patient’s headaches, a physician might prescribe a preventative medication. Beta-blockers, anti-seizure medication, Botox and triptans are all considered first line defenses for prevention. However, a new class of drugs called Calcitonin gene-related peptide (CGRP) monoclonal antibodies, has shown great promise for migraine prevention. Last year, the FDA approved three new medications in this class, Aimovig, Ajovy and Emgality. The drugs are administered as a monthly injection and have shown reduction in frequency of headaches for those who suffer from chronic migraines. The American Headache Association recommends CGRPs as a third line of defense for prevention.
Also, just this spring, the FDA approved a “first-in-category” product for migraine sufferers. Nerivio Migra is worn on the upper arm and delivers smartphone-controlled electronic pulses that relieve migraine through conditioned pain modulation.
If you have frequent headaches, be sure to talk with your provider about diagnosis, treatment and prevention options.